HL7 & Meaningful Use. Charles Jaffe, MD, PhD CEO Health Level Seven International. HIMSS 11 Orlando February 23, 2011

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1 HL7 & Meaningful Use Charles Jaffe, MD, PhD CEO Health Level Seven International HIMSS 11 Orlando February 23, 2011

2 Overview Overview of Meaningful Use HIT Standards and Meaningful Use Overview HL7 Standards Role of HL7 in Meaningful Use in Implementation Evolution of HL7 in Meaningful Use Phases 2 & 3 Certification Summary

3 Introduction Meaningful Use of an EHR In 2008, the National Priorities Partnership, convened by the National Quality Forum (NQF), released a report entitled National Priorities and Goals which identified a set of national priorities to help focus performance improvement efforts Among these priorities were patient engagement, reduction of racial disparities, improved safety, increased efficiency, coordination of care, and improved population health These priorities have been used to create the framework for meaningful use of an electronic health record The ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system.

4 Background 1999 IOM: To Err is Human: Building a Safer Health System 2004 US EO 13335: Upon publication of EO 13335, President also set an ambitious target for the majority of Americans to have access to electronic health records (EHRs) by US EO 13410: promote quality and efficient delivery of health care through the use of health IT 2009 ARRA (US Stimulus Package Legislation) HITECH (The Health Information Technology for Economic and Clinical Health) Act Includes Requirement to deliver Meaningful Use New Requirements for Certification Specified for Federal programs by CMS (trickle down effect) Quality, Cost EHR-S Functional Model, driven by IOM and created by HL7, available for use

5 Meaningful Use - A Key Component of HITECH HITECH was signed into law on February 17, 2009 as part of ARRA ( US stimulus package") HITECH a part of ARRA - $19.2 billion in recovery designated to modernize the health care system Promoting and expanding the adoption of HIT by HITECH establishes programs under Medicare and Medicaid with incentive payments for the Meaningful Use of EHR Health care providers, software vendors, and health IT consultants are all impacted by the HITECH Act. Transformational legislation anticipating expansion in PHI (exchange in protected health information) Widens HIPAAs privacy and security protections, legal liability for noncompliance and EHR meaningful use July 28, 2010: Final Ruling on Meaningful Use

6 Meaningful Use What Does It Mean? HITECH rewards the meaningful use of health IT and not the purchase of health IT. Key components Tracking key patient-level clinical information in order to give health providers clear visibility into the health status of their patient populations Applying clinical decision support designed by health care providers to help improve adherence to evidence-based best practices Executing electronic health care transactions (prescriptions, receipt of drug formulary information, eligibility checking, lab results, basic patient summary data exchange) with key stakeholders Reporting a focused set of meaningful care outcomes and evidence-based process metrics (for example, the percentage of patients with hypertension whose blood pressure is under control), which will be required by virtually any conceivable new value-based payment regimes. Evidence of Meaningful use provides financial incentives to Eligible Providers and Eligible Hospitals

7 Meaningful Use - 3 Stage Implementation Meaningful use implemented in 3 Stages All Eligible Providers and Eligible hospitals must achieve meaningful use by Health IT Enabled Health Reform Stage 1 Capture Data in Coded Format Stage 2 Expand Exchange of Information in Structured Format Possible 2015 Stage 3 Focus on Clinical Decision Support for High Priority Conditions, Patient Management, and Access to Comprehensive Data

8 Meaningful Use Incentive Eligibility CMS controls EHR Incentive Program through regulatory power Defines the provisions for incentive payments to eligible professionals and hospitals participating in Medicare and Medicaid programs that. Incentives a provided to cover costs for acquiring, using and maintaining a certified EHR Incentive payments are only available to the following providers Eligible professionals (EPs) & eligible hospitals (Medicare, Medicaid) Meet or exceed specified Medicaid volumes Adopt and meaningfully use certified EHRs

9 Implementation - Incentives Incentives available to providers who use a certified EHR to improve the overall quality of healthcare delivered by demonstrating achievement of a series of objectives, including but not limited to: Entering orders, medications etc in CPOE Maintaining problem lists in ICD9-CM or Snomed-CT coding Maintain active medication list and electronic prescribing Recording vital signs, smoking status Receive and display lab results encoded with LOINC codes Generate patient lists based on specific conditions and generate patient reminders Provide patients with electronic copy and electronic access to their record and discharge instructions Generate a clinical summary for each visit Exchange clinical data with other providers Protect the information, encrypt it and record disclosures

10 Meaningful Use Quality Reporting Stage 1 meaningful use criteria 1) capturing health information in a coded format, 2) using the information to track key clinical conditions; 3) communicating captured information for care coordination purposes; and 4) reporting of clinical quality measures and public health information. Stage 2 criteria will be defined by end 2011 and expand on Stage 1 Focus on disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement, research, and bi-directional communication with public health agencies. May apply to both the inpatient and outpatient hospital settings. Stage 3 criteria will be defined by the end of Focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self-management tools, access to comprehensive patient data and improving population health outcomes.

11 MPE5 4 Categories of Meaningful Use Information Standards

12 Standards Categories Support Health Outcomes Policy Priorities CPOE is used for at least 80% of all orders Medication reconciliation for at least 80% of relevant encounters Improving quality, safety, efficiency, and reducing health disparities Improve care coordination Conduct or review a security risk analysis per 45 CFR Ensure adequate privacy and security protections for personal health information Engage patients and families in their healthcare At least 80% of all patients who request an electronic copy of their health information are provided it within 48 hours One test of certified EHR technology's capacity to submit electronic data to immunization registries Improve population and public health

13 HL7 One of a Range of Healthcare Standards Improve Patient Care Delivery MPE1 Patient Records Public Health Quality Of Care Electronic Documents Medicines and Dispensing Goal: Standards are an enabler for interoperability of electronic healthcare Information Over 40 recognized standards setting organization exist Claims and Reporting Clinical Research Electronic Health Records Lab Tests Radiology

14 A Family of Standards for EHRs Patient Administration and Demographics Orders and Results for : Clinical Lab/Pathology, Imaging (radiology, ultrasound, etc.) Signs and Symptoms, Diagnosis and Treatments Clinical Research (e.g. Genomics) and Public Health/Disease Surveillance Sharing and re-use of information from many healthcare domains: Pharmacy prescriptions, dispensing and administration Scheduling and managing healthcare resources Claims and Reimbursements Patient Care messages, Clinical Documents (referrals, H&P, Summary record, etc.)

15 HL7 Standards Specified in Meaningful Use HL7 V2 HL7 CDA Certified EHRs certifying criteria's based on HL7 EHR-S FM (Electronic Health Record- System Functional Model) Quality Measure & Reporting

16 HL7 Standards Specified in Meaningful Use HL7 V2 Version for the submission of lab results to public health agencies. Version or Version for submitting information to public health agencies for surveillance or reporting (excluding adverse event reporting). Version or Version for submitting information to immunization registries as the content exchange standard and the CDC maintained HL7 standard code CVX Vaccines Administered as the vocabulary standard. Version Implementation Guide for Electronic Laboratory Reporting to Public Health when HL7 Version is used for reporting lab results to public health agencies HL7 CDA Continuity of Care Document (CCD), a Version 3 standard based on the HL7 Reference Information Model, as one of two options for content exchange standards for the receipt of a patient summary record.

17 Templated CDA: Phases 2 & 3 Streamlined standards development Reusable building blocks. Streamlined standards implementation Implement once, deploy often. Modular and reusable Templates (e.g., blood pressure, discharge diagnosis) can be repackaged with other templates in any number of CDA implementation guides. Core component of CDA s incremental interoperability strategy Begin with simple CDA, and add templates as they are prioritized.

18 Summary HL7 specifications are broadly required in Meaningful Use Stage 1 HL7 provides a solutions for a seamless transition to later stages of Meaningful Use HL7 continues to collaborate with the Office of the National Coordinator within the Standards & Interoperability Framework to facilitate implementation of many solutions HL7 innovation will pave the way for more accelerated and more simplified transition to Stages 2 and 3

19 HL7 & Meaningful Use Q & A cjaffe@hl7.org